Suicide Attempts Linked to General Mental Illness

No specific diagnosis bears the brunt.

Action Points

Note that this large survey study found that any active psychiatric diagnosis was associated with suicide attempt.

Be aware that the overall rate of suicide attempts was low, limiting the authors' ability to model effectively whether particular diagnoses (like depression) increase suicide risk more than others.

TORONTO -- A general predisposition to mental illness, rather than any specific condition, is the major risk factor for suicide attempts, a researcher said here.

In a large representative sample in the U.S., mental disorders were linked to the risk of suicide attempts during a 3-year follow-up, according to Nicolas Hoertel, MD, of the Corentin Celton Hospital in Paris.

The study offers a "fresh view" of the risk factors for suicide, commented Ma-Li Wong, MD, of Flinders University in Adelaide Australia, and an associate editor of the journal, who was not part of the study but who delivered a commentary during the session at which it was presented.

But the study has the potential to begin a paradigm shift in suicide risk assessment, she said, since it shows that particular mental illnesses -- such as depression -- are less central to the issue than had been thought.

"It is not depression that increases the risk of suicide attempts," she said. "It is psychopathology in general."

It's interesting, she added, that the researchers found that mental illness in the past has no direct effect, except to increase the predisposition to current illness.

The survey looked at civilian non-institutionalized U.S. residents who were 18 or older; all told, 70.2% of initial participants were re-interviewed in the second wave, yielding complete data on 34,653 people, Hoertel said.

Investigators assessed Axis I disorders by seeking information on diagnoses in the 12 months before Wave 1, and Axis II disorders on a lifetime basis.

In Wave 1, volunteers who reported a lifetime history of at least one 2-week episode of depressed mood and/or anhedonia were asked whether they had ever felt as if they wanted to die, thought about committing suicide, and whether they had ever attempted suicide.

Wave 2 respondents were asked if they had attempted suicide since the last interview.

Overall, Hoertel reported, 0.5% of men and 0.9% of women reported such an attempt. In men and women who had reported a lifetime history of suicidal ideation, the rates were 2.1% and 3.3%, respectively.

As expected, most men and women who attempted suicide between Waves 1 and 2 -- 75.3% and 66.9%, respectively -- had a past-year DSM-IV Axis I disorder or a lifetime Axis II disorder at Wave 1.

Among those with a history of suicidal ideation, the rates were 90.4% in men and 85.6% in women, Hoertel and colleagues found.

Statistical analysis suggested that a three-dimensional model, describing specific diagnoses as externalizing types or two categories of internalizing types, fit the data well, he said.

But independently of sociodemographic characteristics and history of prior suicide attempts, he said, the shared effects of all disorders accounted for the data, rather than any specific illness.

The findings suggest that interventions aimed at individual disorders are likely to decrease the risk of suicide attempts but those directed at "broader, more global psychopathological processes are likely to have greater effect," the investigators concluded in the journal.

Hoertel cautioned that, while the study was prospective, it couldn't establish any causal relationships. As well, while many disorders were included in the analysis, some were omitted for technical reasons. Finally, he noted, the follow-up was only for 3 years and a longer period might have found a different pattern.

The study had support from the NIH, the New York State Psychiatric Institute, the National Institute on Drug Abuse, and Public Health Expertise. Hoerter said he had no relevant disclosures.

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